Original Article
Materials Used for Suicidal Hanging Recorded during Autopsy
from Sir Salimullah Medical College Morgue
Md Syedur Rahaman Sumon1, Kishoara Binte Quader2, Moushumi Taher Asha3, Ferdows Ara Mollika4
Mustafa Sumon Al Rashid5, Md Belayet Hossain Khan6, Farzana Ahmed7
Abstract
Background: Suicide is one of the commonest causes of death worldwide and has a
great public health effect. The cause of suicide is found to be multi-factorial in which
biological, psychological, social and environmental factors act together. The choice of
method depends on the accessibility and availability of the means on the spot at the time
of act. Objective: To find out the choice of ligature material used by the victims, type of
hanging in relation to the point of suspension and other related factors. Materials and
method: This retrospective observational study summarizes the post mortem
examinations on 187 cases of suicide by hanging during January 2012 to December
2013 in the Department of Forensic Medicine, Sir Salimullah Medical College and
Mitford Hospital, Dhaka, Bangladesh. Ligature material used by the victim was noted
from the available forensic reports. Results: The current study is done to find out the
commonly used material in cases of hanging. Male (63%) outnumbered females (37%)
in committing suicide by hanging. Most commonly used ligature material was rope
(28%) followed by ‘orna’/’dupatta’ (22%). The nature of ligature material was soft in
68% cases while hard material was used in 5% cases. The position of knot was observed
on left side of neck in 63% cases followed by right side in 21% cases. The commonly
used ligature was a rope with guider, and ceiling fan and tree branches as the point of
suspension. Conclusion: Rope is frequently used for domestic purposes and thus it is
also the most commonly used ligature material. Social, cultural and economic values
must be strengthened to reduce incidence of suicide.
Key words: Suicide; hanging; ligature mark; ligature material.
Delta Med Col J. Jul 2019;7(2):66-70
Introduction
Hanging is one of the ten leading causes of death
in the world accounting for more than a million
deaths annually.1 The hanging deaths are one of
1.
2.
3.
4.
5.
6.
7.
the most important asphyxial types of death which
are encountered in day to day life by forensic
pathologists.2 It is a form of violent mechanical
Assistant Professor, Dept. of Forensic Medicine, Bashundhara Ad-din Medical College, Dhaka, Bangladesh.
Assistant Professor, Dept. of Forensic Medicine, Delta Medical College, Dhaka, Bangladesh.
Assistant Professor, Dept. of Anatomy, Bashundhara Ad-din Medical College, Dhaka, Bangladesh.
Lecturer, Dept. of Microbiology, Sapporo Dental College, Dhaka, Bangladesh.
Assistant Professor, Dept. of Forensic Medicine, Aichi Medical College, Uttara, Bangladesh.
Professor & Head, Dept. of Forensic Medicine, Sir Salimullah Medical College, Dhaka, Bangladesh.
Assistant Professor, Dept. of Forensic Medicine, Shahabuddin Medical College, Dhaka, Bangladesh.
Correspondence: Dr. Md Syedur Rahaman Sumon. e-mail: drsumonadib@gmail.com
Delta Med Col J. Jul 2019;7(2)
66
Original Article
asphyxial death in which force applied to the neck
is derived from a gravitational drag of the body or
part of the body.3 In India, hanging is one of the
common methods of committing suicide along
with poisoning, burning and drowning and
constituted 41.8% cases of suicides in 2014.4,5 A
review of data of 56 countries found that hanging
was the most common method in most of the
countries, accounting for 53% of the male suicides
and 39% of the female suicides. According to
WHO, highest incidence of hanging was found to
be 90.6% in Kuwait and 83.1% in Lithuania
among the total number of suicide cases.6,7
Asphyxia in hanging results from compression or
constriction of the neck structures by a noose or
other kind of structure around the neck tightened
by the weight of the body.8 Hanging may be
complete or partial depending on the position of
the body at the time of hanging. In a hanging from
high point of suspension when the body
completely suspends above without touching the
ground is called complete hanging while in a
hanging from low point of suspension sometime
some part of the body touches the ground is called
incomplete or partial hanging. The type and
position of knot play an important role in the
causation of death in hanging.9 The biological,
psychological, socio-cultural economic, and
environmental factors are responsible for the
causation of hangings all over the world. These
factors contribute to the opportunities and
limitations of choice of ligature material to be used
by the person for committing suicide. Rapid
urbanization, industrialization and emerging
nuclear family systems are resulting in social
upheaval and distress.10 Modern period has been a
period of significant development and gradual
changes were noticed in the society all over the
world. The traditional methods of suicide did not
change with the introduction of new technologies
and advancement in the society in India and vary
across country. In the modern era, internet usage is
growing exponentially which is not only shaping
our lives but altering our brain also. The
applications of Wikipedia, blog, or social
networking are being used extensively and the
web postings have become the interactive and
67
self-initiated medium to acquire information about
changing suicide trends in relation to methods
used. In Bangladesh ‘shari’, ‘orna’(‘dopatta’),
‘lungi’, nylon rope, belt, muffler, ropes are
commonly available at home which can be used to
hang themselves at any place and any time and
table, stool, chair and cot are commonly used to
reach the site of suspension. There are unique
patterns of suicide methods in India that markedly
differ from those of the West. This may be due to
cross-cultural differences. In Western countries,
dog chain, belt, electric cable, scarf, tie, dressing
gown cord, shoe lace, etc., are used as ligature
materials, which are not usually used in our
country.11 The present study was conducted with
the objective to study the choice of ligature
material preferred for hanging and the type of
hanging in relation to the point of suspension and
other associated factors.
Materials and method
A retrospective study was done on the basis of 3rd
copies of postmortem reports preserved in the
department of Forensic Medicine, Sir Salimullah
Medical College and Mitford Hospital, Dhaka
Bangladesh for the period of 2 years, (from
January 2012 to December 2013) with the
permission of the autopsy surgeons. A total of 187
cases of hanging were studied with respect to the
ligature material used. The cases included in the
study were the cases of death due to hanging, in
which the postmortem examination was
conducted in this department. The meticulous
examination of ligature material was carried out in
this study.
Results
A total of 187 cases of suicidal hanging were
reported within the period between 2012 and
2013. Age incidence was highest (40%) in
between the age of 21-30 years. Sex distribution
revealed 117(63%) males and 70(37%) females
indicating a male: female ratio of nearly 2:1. Rope
(nylon and jute) was the most common ligature
material used in 53(28%) cases followed by
Delta Med Col J. Jul 2019;7(2)
Original Article
‘orna’/‘dopatta’ in 40(22%) cases and ‘shari’ in
21(12%) cases. Electric wire, clutch wire, ‘lungi’,
‘kamiz’ were other ligature materials used for
hanging. And in 35(18%) cases ligature materials
were unknown. The ligature material most
commonly used for hanging was soft material in
129(68%) cases, firm material in 31(16%) cases,
hard material in 10(5%) cases, and used materials
were unknown in 17(9%) cases. The knot was
observed on left side of neck in 117(63%) cases
and on right side in 49(26%) cases and on nape of
the neck/backside in only 21(11%) cases. Position
of the ligature marks on above thyroid cartilage in
183(98%) cases, below thyroid cartilage in 2(1%)
cases, and over the thyroid cartilage in 2(1%)
cases. The ligature mark was placed obliquely
around the neck in 185(99%) cases. The fracture
of hyoid bone was observed in 9(5%) cases
(Table I).
Table I: Findings of the study (N=187)
Studied variables
Age (in years)
11-20
21-30
31-40
41-50
51-60
>60
Sex
Male
Female
Ligature materials
Rope(nylon, jute)
‘Orna’(‘dopatta’)
‘Shari’
‘Lungi’
‘Kamiz’
Electric wire
Unknown
Nature of ligature material
Soft
Firm
Hard
Unknown
Relevant factors
Position of the ligature mark
Above the thyroid cartilage
Below the thyroid cartilage
Over the thyroid cartilage
Direction of the ligature mark
Oblique
Horizontal
Fracture of hyoid bone
Fractured
Not fractured
Frequency
Percentage
25
75
55
20
10
2
14%
40%
30%
10%
5%
1%
117
70
63%
37%
53
40
21
20
9
8
35
28%
22%
12%
11%
5%
4%
18%
129
31
10
17
68%
16%
5%
9%
183
2
2
98%
1%
1%
185
2
99%
1%
9
178
5%
95%
Discussion
Hanging is one of the most common causes of
suicide deaths in Bangladesh. The present study
Delta Med Col J. Jul 2019;7(2)
revealed that majority of hanging deaths were
among males with a male: female ratio of nearly
2:1, which was consistent with observations made
by a good number of studies.2,3,8,12-16
The present study revealed that the commonest
type of ligature material used for hanging was
synthetic and jute rope in 53(28%) cases followed
by ‘orna’/‘dopatta’ in 40(22%) cases. Similar
findings were reported by Pradhan et al.8, Bhosle
et al.17, Rawat and Rodrigues18 and Ahmad and
Hossain.19 In Western countries belt, electric
cable, scarf, tie, dressing gown cord, shoe lace,
curtain cord, telephone cord, shower lead, etc. are
used as ligature materials, which are not so used in
our country11 and this may be due to socio-cultural
and geographical factors. The current study was
compared with the other studies conducted in
other parts of the world in relation to various
incidences surrounding suicidal hanging. The
results of the present study were contrary to the
observations made by Nowers20 who reported
scarf, shoe laces, electric flex, wire cable and
electric cable as ligature material. Cooke et al.21
noticed rope as ligature material in 59% cases,
James and Silcocks3 reported rope, wire, chain,
flex, belts and various soft ligatures, Simonsen22
reported packing twine, electric cord, rope, linen,
belt and others, Elfawal and Awad23 observed
plastic clothes line, cotton cloth, leather strap, silk
cloth, rubber hose, and electric cable, Guarner and
Hanzlick24 reported ropes and belts, sheets,
electric cords, shirts, towels, and linen clothes
hanger, Davison and Marshall25 reported rope,
electric flex, belts, baler twine, and washing line
and Lukeet al.26 noticed, rope or clothes line,
leather belt, soft belt or tie. The knot was observed
on left side of neck in majority of cases and
position of the ligature marks were on above
thyroid cartilage in most of the cases. The present
study highlighted the fact that the fracture of hyoid
bone was observed in 9(5%) cases. The findings of
the present study regarding hyoid bone were in
concordance with the observations made by
several previous studies.15, 17, 18, 26-32 According to
Modi33 fractures of hyoid bones were rare.
Whereas the study conducted by Smith and
Fiddes34 and Mukherjee35 never found any
fracture.
68
Original Article
Conclusion
The most common ligature material used by
victim for hanging found in this study was rope
followed by ‘Orna’/‘Dopatta’. The ligature
material used in most cases is the easily available
material found by the deceased in the vicinity of
the scene of crime. Social, cultural and economic
values must be strengthened to help reduce
incidence of suicide.
References
1.
2.
Mohanty S, Sagu H, Mohanty MK, Patnaik M.
Suicides in India: A Four Year Retrospective Study. J
Forensic Leg Med. 2007;14(2):185-89.
Ambade VN, Tumran N, Meshram S, Borkar J.
Ligature Material in Hanging Deaths: The Neglected
Area in Forensic Examination. Egypt J Forensic Sci.
2015;5(3):109-13.
11. Bennewith O, Gunnell D, Kapur N, Turnbull P,
Simkin S, Sutton L, et al. Suicide by Hanging:
Multicenter Study Based on Coroners Record in
England. BMJ. 2005;186:260-61.
12. Kumar C, Rana N, Goyal AK, Tanna J, Pathak A,
Patil VR. Epidemiology of Cases of Hanging at
Vadodara, Gujarat. IRPMS. 2015;1(2):23-26.
13. Udhayabanu R, Toshi S, Baskar R. Study of Hanging
Cases in Pondicherry Region. IOSR-J Den Med Sci.
2015;14(7):41-44.
14. Momin SG, Mangal HM, Kyada HC, Vijapur MT,
Bhuva SD. Pattern of Ligature Mark in Cases of
Compressed Neck in Rajkot Region: A Prospective
Study. J Ind Acad Forensic Med. 2012;34(1):40-43.
15. Mukherjee AA, Dhawane SG, Dhoble SV.
Medico-Legal Study of Drowning Deaths: A
Forensic Perspective. J Res Forensic Med Toxicol.
2016;2(1):1-4.
3.
James R, Silcocks P. Suicidal Hanging in Cardiff a
15 Year Retrospective Study. Forensic Sci Int.
1992;56(2):167-75.
16. Yadukul S, Kamal A, Shivakumar BC, Shankar U.
Study of Profile of Ligature Materials Used in Case
of Hanging in Sapthagiri Institute of Medical
Sciences & Research Centre, Bengaluru. Ind J
Forensic Community Med. 2016;3(1):56-59.
4.
Ambade VN, Keoliya AN, Wankhede AG.
Availability of Means of Suicides. Int J Med Toxicol
Leg Med. 2012;14:83-89.
17. Bhosle SH, Batra AK, Kuchewaar SV. Violent
Asphyxia Death Due to Hanging: A Prospective
Study. J Forensic Med Sci Law. 2014;23(1):1-8.
5.
National Crime Records Bureau. Accidental Deaths
and Suicides in India. 2014. Ministry of Home
Affairs Govt. of India, New Delhi.
18. Rawat V, Rodrigues EJ. Medico-Legal Study of
Hanging Cases in North Goa. Int J Med Toxicol and
Legal Med. 2014;16(3-4):57-64.
6.
Ajdacic-Gross V, Weiss MG, Ring M, Hepp U, Bopp
M, Gutzwiller F, et al. Methods of Suicide:
International Suicide Patterns Derived from the
WHO Mortality Database. Bulletin of the World
Health Organization. 2008;86:657-736.
19. Ahmad M, Hossain MZ. Hanging as a Method of
Suicide: Retrospective Analysis of Postmortem
Cases. JAFMC Bangladesh. 2010;6(2):37-39.
7.
8.
9.
O'Connor RC, Stephen P, Jacki G. International
Handbook of Suicide Prevention: Research, Policy
and Practice. New York: John Wiley and Sons;2011.
Pradhan A, Mandal BK, Tripathi CB. Hanging:
Nature of Ligature Material Applied and Type of
Hanging According to Point of Suspension. Nepal
Med Coll J. 2012;14(2):103-106.
Badkur DS, Yadav J, Arora A, Bajpayee R, Dubey
BP. Nomenclature for Knot Position in Hanging - a
Study of 200 Cases. J Indian Acad Forensic Med.
2012;34(1):34-36.
10. Countercurrents.org [Internet]. Kamalakar D. A New
Trend of Suicides in India. 2012 Jul 12 [cited 2015
Aug
12]. Available
from:
http://www.
Countercurrents.org/ Kamalakar210712.htm.
69
20. Nowers M. Violent suicide: Pathways to Prevention
[thesis/dissertation]. Bristol: University of Bristol;
2001.
21. Cooke CT, Cadden GA, Margolius KA. Death by
Hanging in Western Australia. Pathology.
1995;27(3): 268-72.
22. Simonsen J. Patho-Anatomic Findings in Neck
Structures in Asphyxiation Due to Hanging: A
Survey of 80 Cases. Forensic Sci Int. 1988;38
(1-2):83-91.
23. Elfawal MA, Awad OA. Deaths from Hanging in the
Eastern Province of Saudi Arabia. Med Sci Law.
1994;34(4):307-12.
24. Guarner J, Hanzlick R. Suicide by Hanging: A
Review of 56 Cases. Am J Forensic Med Pathol.
1987;8(1):23-26.
Delta Med Col J. Jul 2019;7(2)
Original Article
25. Davison A, Marshall TK. Hanging in Northern
Ireland-A Survey. Med Sci Law. 1986;26(1): 23-28.
26. Luke JL, Reay DT, Eisele JW, Bonnell HJ.
Correlation of Circumstances with Pathological
Finding in Asphyxial Deaths by Hanging. A
Prospective Study of 61 Cases from Seattle, WA. J
Forensic Sci. 1985;30(4):1140-47.
27. Ahmad M, Rahman FN, Hussain MA, Chowdhury
MH, Yasmeen BHN. A Medico Legal Study of
Hanging Cases at Dhaka Medical College. Northern
Int Med Coll J. 2015;7(1):110-14.
28. Rao D. An Autopsy Study of Death Due to Suicidal
Hanging - 264 Cases. Egyptian J Forensic Sci.
2016;6(3):248-54.
29. Reddy KSN. The Essentials of Forensic Medicine &
Toxicology. 24th ed. Hyderabad, India: Medical
Book Co;2005. p. 286-95.
Delta Med Col J. Jul 2019;7(2)
30. Nikolic S, Micic J, Atanasijevic T, Djokic V, Djonic
D. Analysis of Neck Injuries in Hanging. Am J
Forensic Med Path. 2003;24(2):179-82.
31. Nandy A. Principle of Forensic Medicine Including
Toxicology. 3rd ed. New Delhi, India: Central Book
Agency;2010. p. 517-18.
32. Betz P, Eisenmenger W. Frequency of Throat
Skeleton Fracture in Hanging. Americ J Forensic
Med Pathol. 1996;17(3):191-93.
33. Franklin CA. Modi's Medical Jurisprudence and
Toxicology. 21st ed. N M Tripathy Pvt. Ltd:
Bombay; 1988. p. 192.
34. Smith, Sir S, Fiddes FS. Forensic Medicine. 10th ed.
Churchill Livingstone: London;1955. p. 252.
35. Mukherjee JB. Textbook of Forensic Medicine &
Toxicology. 2nd ed. India: Academic Publishers;
1994.
70